Provider First Line Business Practice Location Address:
185 STATE ROUTE 271 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42351-6701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-927-9991
Provider Business Practice Location Address Fax Number:
270-927-9990
Provider Enumeration Date:
08/09/2017