Provider First Line Business Practice Location Address:
35 KENTUCKY RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMALENA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41740-8913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-785-3556
Provider Business Practice Location Address Fax Number:
606-436-5797
Provider Enumeration Date:
08/31/2005