Provider First Line Business Practice Location Address:
1713 ELIZABETHTOWN RD
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:
42754-8128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-259-3003
Provider Business Practice Location Address Fax Number:
270-259-5408
Provider Enumeration Date:
07/02/2007