Provider First Line Business Practice Location Address:
112 E 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42025-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-252-5840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2009