Provider First Line Business Practice Location Address:
1373 W HIGHWAY 635
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCIENCE HILL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42553-9106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-423-2555
Provider Business Practice Location Address Fax Number:
606-423-2555
Provider Enumeration Date:
05/13/2010