Provider First Line Business Practice Location Address:
16030 KY HIGHWAY 1247
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40489-9704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-305-6339
Provider Business Practice Location Address Fax Number:
606-379-5497
Provider Enumeration Date:
07/22/2005