Provider First Line Business Practice Location Address:
27 SCHOOL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRODHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-758-8512
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2008