Provider First Line Business Practice Location Address:
509 E 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47542-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-683-2273
Provider Business Practice Location Address Fax Number:
812-683-3191
Provider Enumeration Date:
04/18/2006