Provider First Line Business Practice Location Address:
135 HOSPITAL LN
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:
47802-4247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-361-9115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2026