Provider First Line Business Practice Location Address:
1755 HWY 259 N.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42210-0118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-597-3721
Provider Business Practice Location Address Fax Number:
270-597-9851
Provider Enumeration Date:
10/20/2006