Provider First Line Business Practice Location Address:
103 E. SOUTH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNFORDVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-579-1095
Provider Business Practice Location Address Fax Number:
270-524-1577
Provider Enumeration Date:
11/16/2011