Provider First Line Business Practice Location Address:
75 E COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARDWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42023-8483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-628-9999
Provider Business Practice Location Address Fax Number:
270-628-3334
Provider Enumeration Date:
05/18/2011