Provider First Line Business Practice Location Address:
220 INTERSTATE PLAZA RD
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:
42765-8400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-505-9009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2020