Provider First Line Business Practice Location Address:
1389 KY HWY 15 NORTH
Provider Second Line Business Practice Location Address:
ST. JOHN NEWMANS MEDICAL PLAZA
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-487-8059
Provider Business Practice Location Address Fax Number:
606-487-1658
Provider Enumeration Date:
12/27/2007