Provider First Line Business Practice Location Address:
8005 US HIGHWAY 60 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-295-6756
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2022