Provider First Line Business Practice Location Address:
635 S MAIN ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEITCHFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-287-0656
Provider Business Practice Location Address Fax Number:
270-230-0328
Provider Enumeration Date:
07/31/2014