Provider First Line Business Practice Location Address:
124 S BRADY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42437-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-389-2855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2006