Provider First Line Business Practice Location Address:
44 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:
42343-9761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-276-9953
Provider Business Practice Location Address Fax Number:
270-276-9958
Provider Enumeration Date:
12/28/2006