Provider First Line Business Practice Location Address:
404 S MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-343-3191
Provider Business Practice Location Address Fax Number:
270-343-3072
Provider Enumeration Date:
02/05/2007