Provider First Line Business Practice Location Address:
2200E PARRISH AVE 104E
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:
42303-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-316-8885
Provider Business Practice Location Address Fax Number:
270-663-1303
Provider Enumeration Date:
09/20/2006