Provider First Line Business Practice Location Address:
44 WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40360-8944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-336-7005
Provider Business Practice Location Address Fax Number:
606-336-7010
Provider Enumeration Date:
02/24/2020