Provider First Line Business Practice Location Address:
2673 HIGHWAY 644
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230-5922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-638-3323
Provider Business Practice Location Address Fax Number:
606-638-3325
Provider Enumeration Date:
04/13/2007