Provider First Line Business Practice Location Address:
1010 ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-663-1240
Provider Business Practice Location Address Fax Number:
270-228-4400
Provider Enumeration Date:
12/11/2009