Provider First Line Business Practice Location Address:
142 ROGER POWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEBREE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42455-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-835-2533
Provider Business Practice Location Address Fax Number:
270-853-9004
Provider Enumeration Date:
09/16/2005