Provider First Line Business Practice Location Address:
4700BUREAU RD S
Provider Second Line Business Practice Location Address:
FCC TERRE HAUTE DENTAL UNIT
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:
812-244-4595
Provider Business Practice Location Address Fax Number:
812-244-4791
Provider Enumeration Date:
08/01/2011