Provider First Line Business Practice Location Address:
205 E ADAIR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42081-9507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-928-2146
Provider Business Practice Location Address Fax Number:
270-928-4492
Provider Enumeration Date:
03/30/2007