Provider First Line Business Practice Location Address:
11105 US HIGHWAY 23 S
Provider Second Line Business Practice Location Address:
HAYNES COMPLES, SUITE 1
Provider Business Practice Location Address City Name:
BETSY LAYNE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41605-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-478-6653
Provider Business Practice Location Address Fax Number:
606-478-6674
Provider Enumeration Date:
03/15/2007