Provider First Line Business Practice Location Address:
2662 KING KELLY COLEMAN HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-358-4211
Provider Business Practice Location Address Fax Number:
606-358-4215
Provider Enumeration Date:
04/07/2008