Provider First Line Business Practice Location Address:
605 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARPSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-336-0246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2020