Provider First Line Business Practice Location Address:
191 W CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42210-8500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-975-4050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2020