Provider First Line Business Practice Location Address:
9571 W STATE ROAD 56
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCH LICK
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47432-9708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-936-3939
Provider Business Practice Location Address Fax Number:
812-936-2992
Provider Enumeration Date:
12/22/2009