Provider First Line Business Practice Location Address:
6356 OLD MUNFORDVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAVE CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42127-9322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-404-4204
Provider Business Practice Location Address Fax Number:
270-773-5899
Provider Enumeration Date:
07/26/2006