Provider First Line Business Practice Location Address:
515 WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164-1167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-708-3503
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2025