Provider First Line Business Practice Location Address:
111 N PUBLIC SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42743-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-932-5271
Provider Business Practice Location Address Fax Number:
270-932-3711
Provider Enumeration Date:
01/27/2006