Provider First Line Business Practice Location Address:
6441 SOUTH HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LICK
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-585-0479
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2019