Provider First Line Business Practice Location Address:
719 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-761-0043
Provider Business Practice Location Address Fax Number:
270-761-0045
Provider Enumeration Date:
07/22/2009