Provider First Line Business Practice Location Address:
HIGHWAY 644
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-638-4888
Provider Business Practice Location Address Fax Number:
606-638-9003
Provider Enumeration Date:
07/20/2005