Provider First Line Business Practice Location Address:
24 LEFT PENHOOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAROLD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41635-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-478-8787
Provider Business Practice Location Address Fax Number:
606-478-4801
Provider Enumeration Date:
10/02/2009