Provider First Line Business Practice Location Address:
813 S MAIN ST
Provider Second Line Business Practice Location Address:
EDMONSON CENTER
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42210-9009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-597-2355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/01/2015