Provider First Line Business Practice Location Address:
24 LEFT PENHOOK RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
HAROLD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41635-7064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-478-7342
Provider Business Practice Location Address Fax Number:
606-478-7350
Provider Enumeration Date:
03/07/2011