Provider First Line Business Practice Location Address:
2135 HIGHWAY 1185
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230-7968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-826-0257
Provider Business Practice Location Address Fax Number:
606-826-0206
Provider Enumeration Date:
09/01/2016