Provider First Line Business Practice Location Address:
44 MCCOY AVENUE, BOX # 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-2871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-821-0677
Provider Business Practice Location Address Fax Number:
270-821-2539
Provider Enumeration Date:
08/15/2006