NPI | LastName | FirstName | MidName | Organization | Mailing Address | City | State | Zip |
1295279958 | KOOISTRA | MILLIE |   |   | 110 CRAWFORD ST | TERRE HAUTE | IN | 478074614 |
1518912971 | MATA | HEATHER | LYNNE |   | 110 CRAWFORD ST | TERRE HAUTE | IN | 478074614 |
1821397688 | MCKANNA | KATHERINE | ROSE |   | 110 CRAWFORD ST | TERRE HAUTE | IN | 47807 |