Provider First Line Business Practice Location Address:
2200 E PARRISH AVENUE
Provider Second Line Business Practice Location Address:
BLDG D, SUITE 100
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-688-1770
Provider Business Practice Location Address Fax Number:
270-688-1780
Provider Enumeration Date:
04/10/2016