Provider First Line Business Practice Location Address:
221 ALLEN 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:
42303-4139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-685-4966
Provider Business Practice Location Address Fax Number:
270-686-8058
Provider Enumeration Date:
07/18/2005