Provider First Line Business Practice Location Address:
195 OLD MAIN ST
Provider Second Line Business Practice Location Address:
SUITE #202
Provider Business Practice Location Address City Name:
MUNFORDVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42765-9119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-524-2001
Provider Business Practice Location Address Fax Number:
270-524-2003
Provider Enumeration Date:
11/02/2010