Provider First Line Business Practice Location Address:
209 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOVERPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40111-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-788-3000
Provider Business Practice Location Address Fax Number:
270-788-6201
Provider Enumeration Date:
06/27/2005