Provider First Line Business Practice Location Address:
2483 HIGHWAY 644 STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-638-3813
Provider Business Practice Location Address Fax Number:
606-638-7384
Provider Enumeration Date:
03/06/2008