Provider First Line Business Practice Location Address:
103 E SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNFORDVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42765-9023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-282-9653
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2021