Provider First Line Business Practice Location Address:
444 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-471-1591
Provider Business Practice Location Address Fax Number:
812-471-6650
Provider Enumeration Date:
10/18/2005