Provider First Line Business Practice Location Address:
2420 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42301-0328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-685-3141
Provider Business Practice Location Address Fax Number:
270-684-4867
Provider Enumeration Date:
06/29/2007