Provider First Line Business Practice Location Address:
920 S MAIN ST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-821-2321
Provider Business Practice Location Address Fax Number:
270-825-1938
Provider Enumeration Date:
08/18/2006