Provider First Line Business Practice Location Address:
81 PUBLIC SQUARE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-265-9036
Provider Business Practice Location Address Fax Number:
270-265-0013
Provider Enumeration Date:
03/23/2007