Provider First Line Business Practice Location Address:
1316 FREDERICA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-686-7999
Provider Business Practice Location Address Fax Number:
270-686-8092
Provider Enumeration Date:
02/06/2007