Provider First Line Business Practice Location Address:
418 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42301-0704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-926-8145
Provider Business Practice Location Address Fax Number:
270-926-8147
Provider Enumeration Date:
12/18/2014