Provider First Line Business Practice Location Address:
517 EAST 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-683-4100
Provider Business Practice Location Address Fax Number:
812-683-4110
Provider Enumeration Date:
08/29/2006