Provider First Line Business Practice Location Address:
230 US HIGHWAY 51 S
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:
42023-8410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-628-3490
Provider Business Practice Location Address Fax Number:
270-628-3810
Provider Enumeration Date:
10/29/2005