Provider First Line Business Practice Location Address:
400 W STATE LINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42041-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-472-1637
Provider Business Practice Location Address Fax Number:
270-472-2277
Provider Enumeration Date:
11/07/2012