Provider First Line Business Practice Location Address:
15853 US HIGHWAY 68 E LOT 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42025-6465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-444-9680
Provider Business Practice Location Address Fax Number:
270-933-1786
Provider Enumeration Date:
06/12/2026