Provider First Line Business Practice Location Address:
7139 STATE ROUTE 56 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEBREE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42455-0009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-835-0145
Provider Business Practice Location Address Fax Number:
270-835-0086
Provider Enumeration Date:
06/25/2006