Provider First Line Business Practice Location Address:
1350 US HIGHWAY 62 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-365-2008
Provider Business Practice Location Address Fax Number:
270-365-2009
Provider Enumeration Date:
07/20/2007