Provider First Line Business Practice Location Address:
8601 HIGHWAY 217
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRACLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40856-9096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-337-5150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2012