Provider First Line Business Practice Location Address:
521 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40360-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-674-6062
Provider Business Practice Location Address Fax Number:
606-674-8140
Provider Enumeration Date:
10/17/2005