Provider First Line Business Practice Location Address:
201 E ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-267-9057
Provider Business Practice Location Address Fax Number:
502-267-9098
Provider Enumeration Date:
11/07/2005