Provider First Line Business Practice Location Address:
183 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWESVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42348-0235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-927-8585
Provider Business Practice Location Address Fax Number:
270-927-8911
Provider Enumeration Date:
11/16/2006