Provider First Line Business Practice Location Address:
270 FIRST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAVIES
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41727-9091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-487-8188
Provider Business Practice Location Address Fax Number:
606-487-0928
Provider Enumeration Date:
10/24/2005