Provider First Line Business Practice Location Address:
620 S. MAIN ST.
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:
42220-0870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-265-5140
Provider Business Practice Location Address Fax Number:
270-265-5140
Provider Enumeration Date:
12/11/2006