Provider First Line Business Practice Location Address:
218 S LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42141-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-651-3466
Provider Business Practice Location Address Fax Number:
270-659-0633
Provider Enumeration Date:
11/16/2006