Provider First Line Business Practice Location Address:
1350 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-3380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-821-9960
Provider Business Practice Location Address Fax Number:
270-821-9960
Provider Enumeration Date:
06/27/2006