Provider First Line Business Practice Location Address:
117 MERCHANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-384-5772
Provider Business Practice Location Address Fax Number:
270-380-1778
Provider Enumeration Date:
04/20/2006