Provider First Line Business Practice Location Address:
34 ORCHARD ST
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:
42301-0645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-414-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2026