Provider First Line Business Practice Location Address:
7956 KY HIGHWAY 610 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENKINS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41537-8303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-661-7076
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2012