Provider First Line Business Practice Location Address:
1368 HIGHWAY 192 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40741-3123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-864-6680
Provider Business Practice Location Address Fax Number:
606-864-7310
Provider Enumeration Date:
10/19/2005