Provider First Line Business Practice Location Address:
1190 BEAVER DAM CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42210-8531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-597-9739
Provider Business Practice Location Address Fax Number:
270-597-9739
Provider Enumeration Date:
07/15/2025