Provider First Line Business Practice Location Address:
3315 S 7TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-7424
Provider Business Practice Location Address Fax Number:
812-234-4324
Provider Enumeration Date:
08/26/2006