Provider First Line Business Practice Location Address:
221 S 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:
47807-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-242-3105
Provider Business Practice Location Address Fax Number:
812-242-3133
Provider Enumeration Date:
08/31/2006