Provider First Line Business Practice Location Address:
416 SCOTTSVILLE ST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-932-5231
Provider Business Practice Location Address Fax Number:
270-932-3624
Provider Enumeration Date:
11/14/2007