Provider First Line Business Practice Location Address:
226 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADAIRVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42202-7850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-539-7711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2008