Provider First Line Business Practice Location Address:
181 S LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POSEYVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47633-8600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-874-2814
Provider Business Practice Location Address Fax Number:
812-874-3369
Provider Enumeration Date:
10/10/2005