Provider First Line Business Practice Location Address:
2983 SOUTH HIGHWAY 421
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962-2983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-598-0598
Provider Business Practice Location Address Fax Number:
606-598-0610
Provider Enumeration Date:
04/25/2012