Provider First Line Business Practice Location Address:
148 CARNES LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42629-6725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-343-3909
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2008