Provider First Line Business Practice Location Address: 
132 S PUBLIC SQ
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
GLASGOW
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
42141-2434
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
270-651-5246
    Provider Business Practice Location Address Fax Number: 
270-651-1965
    Provider Enumeration Date: 
12/21/2006