Provider First Line Business Practice Location Address:
416 N WATERFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42031-8400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-653-2341
Provider Business Practice Location Address Fax Number:
270-653-6007
Provider Enumeration Date:
08/27/2009