Provider First Line Business Practice Location Address:
414 EAST 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-527-3900
Provider Business Practice Location Address Fax Number:
270-527-3901
Provider Enumeration Date:
09/06/2006