Provider First Line Business Practice Location Address:
MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENKINS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41537-0074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-832-2182
Provider Business Practice Location Address Fax Number:
606-832-2182
Provider Enumeration Date:
01/29/2007