Provider First Line Business Practice Location Address:
222 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42141-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-629-6836
Provider Business Practice Location Address Fax Number:
270-629-6837
Provider Enumeration Date:
10/01/2012