Provider First Line Business Practice Location Address:
148 EAST KENTUCKY DR,
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CENTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-665-9557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2009