Provider First Line Business Practice Location Address:
4671 S US HIGHWAY 25 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIMBLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-2598
Provider Business Practice Location Address Fax Number:
606-545-0497
Provider Enumeration Date:
03/31/2006