Provider First Line Business Practice Location Address:
1094 CHILDS BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENKINS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-832-0146
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2010