Provider First Line Business Practice Location Address:
68 OBERLINE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40360-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-674-3204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2012