Provider First Line Business Practice Location Address:
501 E HOSPITAL LN
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-4230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-234-0707
Provider Business Practice Location Address Fax Number:
812-234-3352
Provider Enumeration Date:
12/22/2006