Provider First Line Business Practice Location Address:
203 EAST ADAIR ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42081-0010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-928-2161
Provider Business Practice Location Address Fax Number:
270-928-2293
Provider Enumeration Date:
09/06/2005