Provider First Line Business Practice Location Address:
41 S. COURT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40360-1088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-674-8822
Provider Business Practice Location Address Fax Number:
606-674-8262
Provider Enumeration Date:
11/29/2011