Provider First Line Business Practice Location Address:
112 S PUBLIC SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42743-1533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-932-4284
Provider Business Practice Location Address Fax Number:
270-932-4285
Provider Enumeration Date:
03/29/2007