Provider First Line Business Practice Location Address:
1451 N GARDNER HWY 31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-752-8592
Provider Business Practice Location Address Fax Number:
812-752-8593
Provider Enumeration Date:
05/22/2007