Provider First Line Business Practice Location Address:
1417 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-343-2597
Provider Business Practice Location Address Fax Number:
270-343-2598
Provider Enumeration Date:
12/08/2006