Provider First Line Business Practice Location Address:
82 SPRUCE ST
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-495-9200
Provider Business Practice Location Address Fax Number:
561-495-0210
Provider Enumeration Date:
07/19/2005