Provider First Line Business Practice Location Address:
9055 ST RT 132 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-664-2270
Provider Business Practice Location Address Fax Number:
270-664-6633
Provider Enumeration Date:
08/24/2006