Provider First Line Business Practice Location Address:
202 WEST 7TH ST
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BLDG STE 117
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-864-7316
Provider Business Practice Location Address Fax Number:
606-878-0590
Provider Enumeration Date:
06/20/2006