Provider First Line Business Practice Location Address:
663 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNFORDVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42765-9436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-524-5422
Provider Business Practice Location Address Fax Number:
270-524-5847
Provider Enumeration Date:
10/18/2011