Provider First Line Business Practice Location Address:
100 1ST BAPTIST CHURCH RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITLEY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42653-0247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-5601
Provider Business Practice Location Address Fax Number:
606-376-3088
Provider Enumeration Date:
01/08/2007