Provider First Line Business Practice Location Address:
2200 E PARRISH AVE
Provider Second Line Business Practice Location Address:
STE LL103 BLDG B
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-926-2122
Provider Business Practice Location Address Fax Number:
270-684-8788
Provider Enumeration Date:
02/10/2006