Provider First Line Business Practice Location Address:
349 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46160-9541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-597-4237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2005