Provider First Line Business Practice Location Address:
20 S. HAZZARD ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47170-1232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-752-5656
Provider Business Practice Location Address Fax Number:
812-752-2257
Provider Enumeration Date:
09/06/2012