Individual
MOLLY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1725 N 5TH ST, TERRE HAUTE, IN 47804-4010
(812) 238-7210
Mailing address
25 CIRCLE, TERRE HAUTE, IN 47803-1423
(812) 242-3049
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
05011084A
IN
Other
Enumeration date
02/12/2014
Last updated
02/12/2014
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