Provider First Line Business Practice Location Address:
6277 LACENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACENTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-908-0461
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2017