Provider First Line Business Practice Location Address:
313 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORDSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42343-9763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-276-3603
Provider Business Practice Location Address Fax Number:
270-276-3031
Provider Enumeration Date:
05/20/2012