Provider First Line Business Practice Location Address:
810 EAST VINE STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-762-1100
Provider Business Practice Location Address Fax Number:
270-752-2290
Provider Enumeration Date:
10/17/2005