Provider First Line Business Practice Location Address:
19 MEDICAL LOOP STE 3
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:
42653-4382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-5391
Provider Business Practice Location Address Fax Number:
606-376-3326
Provider Enumeration Date:
10/31/2008