Provider First Line Business Practice Location Address:
1530 N. 7TH STREET
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-238-4467
Provider Business Practice Location Address Fax Number:
812-238-4469
Provider Enumeration Date:
02/23/2009