Provider First Line Business Practice Location Address:
1084 VETERANS MEMORIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164-9602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-237-3123
Provider Business Practice Location Address Fax Number:
270-237-3139
Provider Enumeration Date:
02/03/2014