Provider First Line Business Practice Location Address:
1010 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWDERLY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42367-5463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-377-1600
Provider Business Practice Location Address Fax Number:
370-338-0229
Provider Enumeration Date:
05/30/2007