Provider First Line Business Practice Location Address:
117 WINGATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42141-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-361-2718
Provider Business Practice Location Address Fax Number:
270-361-2718
Provider Enumeration Date:
10/24/2006