Provider First Line Business Practice Location Address:
5 JOHNSON SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNFORDVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42765-9323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-202-1825
Provider Business Practice Location Address Fax Number:
270-524-1269
Provider Enumeration Date:
03/13/2007