Provider First Line Business Practice Location Address:
1134 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNFORDVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42765-9432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-524-3641
Provider Business Practice Location Address Fax Number:
270-524-7595
Provider Enumeration Date:
08/29/2006