Provider First Line Business Practice Location Address:
332 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEITCHFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42754-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-971-1388
Provider Business Practice Location Address Fax Number:
270-297-7066
Provider Enumeration Date:
04/12/2012