Provider First Line Business Practice Location Address:
71 ORPHANAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. MITCHELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-0880
Provider Business Practice Location Address Fax Number:
859-331-6177
Provider Enumeration Date:
10/04/2006