Provider First Line Business Practice Location Address:
220 E ELKHORN ST
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:
41522-8558
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:
11/23/2021