Provider First Line Business Practice Location Address:
1893 RED FOX RD.
Provider Second Line Business Practice Location Address:
BOX 98
Provider Business Practice Location Address City Name:
RED FOX
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41847-0098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-642-3250
Provider Business Practice Location Address Fax Number:
606-642-3740
Provider Enumeration Date:
08/21/2007