Provider First Line Business Practice Location Address:
201 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEITCHFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42754-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-259-3125
Provider Business Practice Location Address Fax Number:
270-259-0407
Provider Enumeration Date:
09/13/2006