Provider First Line Business Practice Location Address:
90 MEDICAL LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITLEY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-2466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2007