Provider First Line Business Practice Location Address:
604 S 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-753-1361
Provider Business Practice Location Address Fax Number:
270-753-1369
Provider Enumeration Date:
01/24/2006