Provider First Line Business Practice Location Address:
2200 EAST PARRISH AVE. BUILDING E. SUITE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-852-1655
Provider Business Practice Location Address Fax Number:
270-297-4962
Provider Enumeration Date:
09/13/2008