Provider First Line Business Practice Location Address:
13520 HIGHWAY 119 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARTRIDGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40862-6417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-589-4586
Provider Business Practice Location Address Fax Number:
606-589-5930
Provider Enumeration Date:
08/18/2008