Provider First Line Business Practice Location Address:
300 S 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 284W
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-221-7892
Provider Business Practice Location Address Fax Number:
901-682-6915
Provider Enumeration Date:
06/18/2006