Provider First Line Business Practice Location Address:
9350 US HWY 23 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
STANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-478-1005
Provider Business Practice Location Address Fax Number:
606-478-8687
Provider Enumeration Date:
01/25/2007