Provider First Line Business Practice Location Address:
112 E MCMURTRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42347-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-298-7225
Provider Business Practice Location Address Fax Number:
270-298-4084
Provider Enumeration Date:
08/15/2005