Provider First Line Business Practice Location Address:
403 W FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDDYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42038-8259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-908-2500
Provider Business Practice Location Address Fax Number:
270-969-2808
Provider Enumeration Date:
12/27/2006