Provider First Line Business Practice Location Address:
98 POST OFFICE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-663-7788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2014