Provider First Line Business Practice Location Address:
2400 FRIENDSHIP DRIVE, SUITE B
Provider Second Line Business Practice Location Address:
RONALD LOGSDON COMMUNITY CENTER AT PRESIDENTS PLACE
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-852-6516
Provider Business Practice Location Address Fax Number:
270-683-9771
Provider Enumeration Date:
12/11/2013