Provider First Line Business Practice Location Address:
127 HIGHWAY 1084
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAXTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40806-8446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-621-0640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2023