Provider First Line Business Practice Location Address:
1200 NORTH HIGHWAY 27
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITLEY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-8020
Provider Business Practice Location Address Fax Number:
606-376-8055
Provider Enumeration Date:
07/31/2007