Provider First Line Business Practice Location Address:
205 W HIGHWAY 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40146-6284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-547-7161
Provider Business Practice Location Address Fax Number:
270-547-7163
Provider Enumeration Date:
09/08/2014