Provider First Line Business Practice Location Address:
7107 STATE ROUTE 56 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEBREE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-835-7544
Provider Business Practice Location Address Fax Number:
270-835-2226
Provider Enumeration Date:
10/13/2006