Provider First Line Business Practice Location Address:
400 MERCHANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42728-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-273-8451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2023