Provider First Line Business Practice Location Address:
200 W RESERVOIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-754-3131
Provider Business Practice Location Address Fax Number:
270-754-3133
Provider Enumeration Date:
04/17/2007