Provider First Line Business Practice Location Address:
316 E SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-948-5311
Provider Business Practice Location Address Fax Number:
812-948-5313
Provider Enumeration Date:
06/27/2005