Provider First Line Business Practice Location Address:
5010 BACK SQUARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42301-7413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-686-7000
Provider Business Practice Location Address Fax Number:
270-926-4448
Provider Enumeration Date:
06/23/2005