Provider First Line Business Practice Location Address:
77 E NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-821-2468
Provider Business Practice Location Address Fax Number:
270-825-2509
Provider Enumeration Date:
01/09/2007