Provider First Line Business Practice Location Address:
506 N 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:
42437-1252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-559-4994
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2012