Provider First Line Business Practice Location Address:
2200 EAST PARRISH AVENUE
Provider Second Line Business Practice Location Address:
BUILDING C - SUITE 201
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-683-3269
Provider Business Practice Location Address Fax Number:
270-689-9107
Provider Enumeration Date:
12/18/2006