Provider First Line Business Practice Location Address:
300 MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-338-6650
Provider Business Practice Location Address Fax Number:
270-338-6653
Provider Enumeration Date:
09/01/2006