Provider First Line Business Practice Location Address:
166 HOSPITAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42633-2430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-340-3251
Provider Business Practice Location Address Fax Number:
606-340-3258
Provider Enumeration Date:
09/28/2016