Provider First Line Business Practice Location Address:
70 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCHBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40322-8318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-768-2131
Provider Business Practice Location Address Fax Number:
606-768-2134
Provider Enumeration Date:
08/04/2006