Provider First Line Business Practice Location Address:
27 BALLPARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-874-1444
Provider Business Practice Location Address Fax Number:
606-874-1446
Provider Enumeration Date:
09/08/2008