Provider First Line Business Practice Location Address:
97 E HALT DR
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:
47802-4285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-238-2100
Provider Business Practice Location Address Fax Number:
812-232-7772
Provider Enumeration Date:
04/27/2006