Provider First Line Business Practice Location Address:
35 WEST MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRODHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-758-9333
Provider Business Practice Location Address Fax Number:
606-758-4079
Provider Enumeration Date:
12/27/2006