Provider First Line Business Practice Location Address:
309 EMBERTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42167-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-487-5456
Provider Business Practice Location Address Fax Number:
270-487-5571
Provider Enumeration Date:
02/05/2007