Provider First Line Business Practice Location Address:
127 E NORTH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-821-7739
Provider Business Practice Location Address Fax Number:
270-821-0278
Provider Enumeration Date:
07/17/2006