Provider First Line Business Practice Location Address:
2200 E PARRISH AVE STE 105C
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:
42303-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-691-2699
Provider Business Practice Location Address Fax Number:
270-691-2677
Provider Enumeration Date:
10/31/2006