Provider First Line Business Practice Location Address:
141 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-988-3230
Provider Business Practice Location Address Fax Number:
270-988-4230
Provider Enumeration Date:
10/05/2006