Provider First Line Business Practice Location Address:
675 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42210-9008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-975-3784
Provider Business Practice Location Address Fax Number:
270-975-3785
Provider Enumeration Date:
03/20/2023