Provider First Line Business Practice Location Address:
408 N MORGAN 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:
42437-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-389-4559
Provider Business Practice Location Address Fax Number:
270-389-9496
Provider Enumeration Date:
08/09/2012