Provider First Line Business Practice Location Address:
U.S .23 & 39 MILDRED AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH SHORE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41175-0767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-932-3033
Provider Business Practice Location Address Fax Number:
606-932-9335
Provider Enumeration Date:
03/02/2006