Provider First Line Business Practice Location Address:
3212 N 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47804-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-460-1400
Provider Business Practice Location Address Fax Number:
812-460-1402
Provider Enumeration Date:
09/24/2019