Provider First Line Business Practice Location Address:
118 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42220-0895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-265-5040
Provider Business Practice Location Address Fax Number:
270-265-5235
Provider Enumeration Date:
12/22/2005