Provider First Line Business Practice Location Address:
162 HIGHWAY 522
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:
40806-8562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-574-0123
Provider Business Practice Location Address Fax Number:
606-574-0198
Provider Enumeration Date:
03/01/2007