Provider First Line Business Practice Location Address:
1300 E 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-0337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-848-0180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2019