Provider First Line Business Practice Location Address:
920 JAMESTOWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42728-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-384-4474
Provider Business Practice Location Address Fax Number:
270-384-9553
Provider Enumeration Date:
10/03/2006