Provider First Line Business Practice Location Address:
1402 ARGILLITE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLATWOODS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-836-1646
Provider Business Practice Location Address Fax Number:
606-836-0030
Provider Enumeration Date:
02/27/2007