Provider First Line Business Practice Location Address:
103 EAST SOUTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNFORDVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42765-9023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-696-3181
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2018