Provider First Line Business Practice Location Address:
9795 HWY 550 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUSIE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-946-2132
Provider Business Practice Location Address Fax Number:
606-946-2629
Provider Enumeration Date:
07/05/2007