Provider First Line Business Practice Location Address:
1215 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42101-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-782-1116
Provider Business Practice Location Address Fax Number:
270-782-9108
Provider Enumeration Date:
12/27/2013