Provider First Line Business Practice Location Address:
218 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-308-5171
Provider Business Practice Location Address Fax Number:
888-613-3581
Provider Enumeration Date:
04/06/2026