Provider First Line Business Practice Location Address:
115 S TOWNSEND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42437-1470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-389-9555
Provider Business Practice Location Address Fax Number:
270-389-4922
Provider Enumeration Date:
02/12/2007