Provider First Line Business Practice Location Address:
2200 E PARRISH AVE
Provider Second Line Business Practice Location Address:
BLDG C STE 104
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-852-1632
Provider Business Practice Location Address Fax Number:
270-852-1633
Provider Enumeration Date:
05/17/2006