Provider First Line Business Practice Location Address:
507 E PARRISH AVE
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:
42303-3126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-852-9355
Provider Business Practice Location Address Fax Number:
270-852-1870
Provider Enumeration Date:
10/24/2005