Provider First Line Business Practice Location Address:
318 PUBLIC SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42728-1456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-384-3481
Provider Business Practice Location Address Fax Number:
270-385-9866
Provider Enumeration Date:
11/14/2007