Provider First Line Business Practice Location Address:
2200 E PARRISH AVE
Provider Second Line Business Practice Location Address:
BLDG B SUITE 101
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-683-3232
Provider Business Practice Location Address Fax Number:
270-852-1600
Provider Enumeration Date:
07/28/2006