Provider First Line Business Practice Location Address:
747 COUNTY HOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42167-9103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-434-2567
Provider Business Practice Location Address Fax Number:
270-434-2567
Provider Enumeration Date:
12/31/2012