Provider First Line Business Practice Location Address:
218 N COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-237-3351
Provider Business Practice Location Address Fax Number:
270-237-9091
Provider Enumeration Date:
05/21/2008