Provider First Line Business Practice Location Address:
1058 CHALYBEATE SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHS GROVE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42171-7245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-597-2379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2008