Provider First Line Business Practice Location Address:
110 S 2ND 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:
42330-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-931-2059
Provider Business Practice Location Address Fax Number:
270-931-2079
Provider Enumeration Date:
11/05/2012