Provider First Line Business Practice Location Address:
1572 PLANK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-4250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-228-2252
Provider Business Practice Location Address Fax Number:
812-282-3890
Provider Enumeration Date:
11/14/2006