Provider First Line Business Practice Location Address:
10824 US HIGHWAY 23 S STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETSY LAYNE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41605-7062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-478-1111
Provider Business Practice Location Address Fax Number:
606-478-1113
Provider Enumeration Date:
09/13/2005