Provider First Line Business Practice Location Address:
10616 SOUTH KY HWY 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCUDDY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-476-2189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2020