Provider First Line Business Practice Location Address:
1024 S 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47807-5015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-3338
Provider Business Practice Location Address Fax Number:
812-234-8828
Provider Enumeration Date:
09/17/2009