Provider First Line Business Practice Location Address:
260 COMMERCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDDYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42038-8294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-388-9712
Provider Business Practice Location Address Fax Number:
270-388-9713
Provider Enumeration Date:
02/20/2007