Provider First Line Business Practice Location Address:
106 PADGETT DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-653-5558
Provider Business Practice Location Address Fax Number:
270-653-5522
Provider Enumeration Date:
12/02/2005