Provider First Line Business Practice Location Address:
17310 E HIGHWAY 144
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION STAR
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40171-6133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-668-2447
Provider Business Practice Location Address Fax Number:
270-668-2447
Provider Enumeration Date:
07/07/2025