Provider First Line Business Practice Location Address:
1096 LONG BR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARGILLITE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41121-8593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-831-4148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2013