Provider First Line Business Practice Location Address:
1520 KY ROUTE 1428
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERHILL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41222-8646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-789-3841
Provider Business Practice Location Address Fax Number:
606-789-1527
Provider Enumeration Date:
03/24/2006