Provider First Line Business Practice Location Address:
6450 KY ROUTE 1428
Provider Second Line Business Practice Location Address:
STE. 2
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-874-0509
Provider Business Practice Location Address Fax Number:
606-874-0590
Provider Enumeration Date:
06/27/2016