Provider First Line Business Practice Location Address: 
900 HOSPITAL DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
MADISONVILLE
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
42431-1644
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
270-825-5100
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/27/2021