Provider First Line Business Practice Location Address:
1906 COLLEGE HEIGHTS BLVD. #21030
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHOLOGY, WESTERN KENTUCKY UNIVERSITY
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42101-1030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-745-2114
Provider Business Practice Location Address Fax Number:
270-745-6934
Provider Enumeration Date:
02/03/2016