Provider First Line Business Practice Location Address:
117 EAST MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-988-3839
Provider Business Practice Location Address Fax Number:
270-988-3832
Provider Enumeration Date:
02/18/2014