Provider First Line Business Practice Location Address:
220 ELKHORN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHORN CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41522-0439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-754-5076
Provider Business Practice Location Address Fax Number:
606-754-5557
Provider Enumeration Date:
02/19/2008