Provider First Line Business Practice Location Address:
1660 US HIGHWAY 60 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEDBETTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42058-9557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-898-1388
Provider Business Practice Location Address Fax Number:
270-898-1389
Provider Enumeration Date:
08/13/2006