Provider First Line Business Practice Location Address:
66 CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITLEY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-3300
Provider Business Practice Location Address Fax Number:
606-376-3330
Provider Enumeration Date:
11/14/2011