Provider First Line Business Practice Location Address:
1500 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INEZ
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-218-3500
Provider Business Practice Location Address Fax Number:
606-218-4560
Provider Enumeration Date:
12/02/2005