Provider First Line Business Practice Location Address:
103 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42167-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-487-6066
Provider Business Practice Location Address Fax Number:
270-487-8689
Provider Enumeration Date:
03/18/2007