Provider First Line Business Practice Location Address:
412 N KENTUCKY AVE
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:
42431-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-821-5242
Provider Business Practice Location Address Fax Number:
270-825-0138
Provider Enumeration Date:
06/23/2008