Provider First Line Business Practice Location Address:
2200 E PARRISH AVE
Provider Second Line Business Practice Location Address:
STE 203 BLDG C
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-686-0055
Provider Business Practice Location Address Fax Number:
270-686-0056
Provider Enumeration Date:
12/06/2007