Provider First Line Business Practice Location Address:
1417 N. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-343-4443
Provider Business Practice Location Address Fax Number:
270-343-4481
Provider Enumeration Date:
04/16/2010