Provider First Line Business Practice Location Address:
68 MEDICAL LN
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:
42653-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-4444
Provider Business Practice Location Address Fax Number:
606-376-3444
Provider Enumeration Date:
07/07/2005