Provider First Line Business Practice Location Address:
102 W BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42330-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-754-1545
Provider Business Practice Location Address Fax Number:
270-754-9069
Provider Enumeration Date:
03/22/2023