Provider First Line Business Practice Location Address:
118 WEST UNION 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-524-9883
Provider Business Practice Location Address Fax Number:
270-524-0437
Provider Enumeration Date:
02/09/2007