Provider First Line Business Practice Location Address:
132 E MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-403-2010
Provider Business Practice Location Address Fax Number:
859-403-2012
Provider Enumeration Date:
08/24/2014