Provider First Line Business Practice Location Address:
200 E LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164-1275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-237-5070
Provider Business Practice Location Address Fax Number:
270-237-5020
Provider Enumeration Date:
03/20/2008