Provider First Line Business Practice Location Address:
1140 WABASH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42784-9222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-766-7676
Provider Business Practice Location Address Fax Number:
270-246-9774
Provider Enumeration Date:
06/11/2019