Provider First Line Business Practice Location Address:
210 S MAIN ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42210-9001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-975-4050
Provider Business Practice Location Address Fax Number:
866-809-8145
Provider Enumeration Date:
03/14/2007