Provider First Line Business Practice Location Address:
2780 MOSCOW AVE
Provider Second Line Business Practice Location Address:
FULTON CO ELE & HS
Provider Business Practice Location Address City Name:
HICKMAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-236-3923
Provider Business Practice Location Address Fax Number:
270-236-2184
Provider Enumeration Date:
01/31/2007