Provider First Line Business Practice Location Address:
178 US HIGHWAY 51 N STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARDWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42023-9096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-628-5445
Provider Business Practice Location Address Fax Number:
270-628-3179
Provider Enumeration Date:
04/07/2021