Provider First Line Business Practice Location Address:
3221 FREDERICA ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42301-6086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-926-2212
Provider Business Practice Location Address Fax Number:
270-926-2215
Provider Enumeration Date:
07/29/2008