Provider First Line Business Practice Location Address:
679 S STATE ROAD 145
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCH LICK
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47432-8328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-936-6400
Provider Business Practice Location Address Fax Number:
812-936-6402
Provider Enumeration Date:
08/17/2006