Provider First Line Business Practice Location Address:
62 KIRK PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INEZ
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41224-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-298-7774
Provider Business Practice Location Address Fax Number:
606-298-4975
Provider Enumeration Date:
01/30/2007