Provider First Line Business Practice Location Address:
1755 NORTH HIGHWAY 27
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:
42653-0517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-7171
Provider Business Practice Location Address Fax Number:
606-376-7178
Provider Enumeration Date:
08/31/2006