Provider First Line Business Practice Location Address:
1700 FREDERICA ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42301-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-684-3247
Provider Business Practice Location Address Fax Number:
270-684-3248
Provider Enumeration Date:
05/30/2007