Provider First Line Business Practice Location Address:
450 N 7TH ST
Provider Second Line Business Practice Location Address:
ROOT HALL
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47809-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-237-3317
Provider Business Practice Location Address Fax Number:
812-237-8595
Provider Enumeration Date:
08/30/2006