Provider First Line Business Practice Location Address: 
2831 NEW HARTFORD RD
    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: 
42303-1320
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
270-926-4100
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/03/2020