Provider First Line Business Practice Location Address:
2200 E PARRISH AVE.
Provider Second Line Business Practice Location Address:
BLDG B, STE 203
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-691-9697
Provider Business Practice Location Address Fax Number:
270-691-0485
Provider Enumeration Date:
08/31/2009