Provider First Line Business Practice Location Address:
1210 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42351-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-295-6450
Provider Business Practice Location Address Fax Number:
270-295-6452
Provider Enumeration Date:
10/17/2016