Provider First Line Business Practice Location Address:
784 HIGHWAY 36
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCHBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40322-8123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-768-9190
Provider Business Practice Location Address Fax Number:
606-768-9180
Provider Enumeration Date:
08/06/2012