Provider First Line Business Practice Location Address:
1429 N 6TH ST
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:
47807-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-242-3170
Provider Business Practice Location Address Fax Number:
812-235-3330
Provider Enumeration Date:
08/21/2006