Provider First Line Business Practice Location Address:
201 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDDYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42038-7752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-388-2236
Provider Business Practice Location Address Fax Number:
855-849-2214
Provider Enumeration Date:
11/17/2020