Provider First Line Business Practice Location Address:
9350 US HIGHWAY 23 S
Provider Second Line Business Practice Location Address:
BOX 205
Provider Business Practice Location Address City Name:
STANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41659-9001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-478-6653
Provider Business Practice Location Address Fax Number:
606-478-6674
Provider Enumeration Date:
06/13/2006