Provider First Line Business Practice Location Address:
113 FRANK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAFFORDSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41256-9098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-886-7480
Provider Business Practice Location Address Fax Number:
606-886-7573
Provider Enumeration Date:
08/16/2011