Provider First Line Business Practice Location Address:
3021 N 13TH ST
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47804-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-229-6243
Provider Business Practice Location Address Fax Number:
812-213-4182
Provider Enumeration Date:
10/09/2007