Provider First Line Business Practice Location Address:
131 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42078-8043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-988-2299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2006