Provider First Line Business Practice Location Address:
5500 S US HIGHWAY 41
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-4745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-238-7786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2025