Provider First Line Business Practice Location Address:
201 E 2ND ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TOMPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42167-1673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-487-5655
Provider Business Practice Location Address Fax Number:
270-487-5948
Provider Enumeration Date:
10/16/2007