Provider First Line Business Practice Location Address:
1134 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TELL CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47586-1827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-547-5586
Provider Business Practice Location Address Fax Number:
812-547-4368
Provider Enumeration Date:
05/05/2006