Provider First Line Business Practice Location Address:
509 N CARRIER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42437-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-394-1145
Provider Business Practice Location Address Fax Number:
812-477-7240
Provider Enumeration Date:
07/18/2013