Provider First Line Business Practice Location Address:
10363 REGINA BELCHER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHORN CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-794-7085
Provider Business Practice Location Address Fax Number:
606-754-3049
Provider Enumeration Date:
06/06/2012