Provider First Line Business Practice Location Address:
1616 HIGHWAY 121 NORTH
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071-0016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-753-1434
Provider Business Practice Location Address Fax Number:
270-759-9166
Provider Enumeration Date:
11/18/2005