Provider First Line Business Practice Location Address:
1010 MEDICAL CENTER DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWDERLY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-377-1609
Provider Business Practice Location Address Fax Number:
270-377-1682
Provider Enumeration Date:
08/09/2005