Provider First Line Business Practice Location Address:
141 N MAIN ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN,KY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-343-4443
Provider Business Practice Location Address Fax Number:
800-541-3781
Provider Enumeration Date:
09/05/2024