Provider First Line Business Practice Location Address:
82 SPRUCE STREET BUSINESS CENTER
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-767-1520
Provider Business Practice Location Address Fax Number:
866-233-9220
Provider Enumeration Date:
08/07/2006