Provider First Line Business Practice Location Address:
93 ISOM PLAZA BOX 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISOM
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-9238
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007