Provider First Line Business Practice Location Address:
204 SOUTH 9TH ST
Provider Second Line Business Practice Location Address:
STE A
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:
270-759-4199
Provider Business Practice Location Address Fax Number:
270-767-3632
Provider Enumeration Date:
08/31/2005