Provider First Line Business Practice Location Address:
11901 N HIGHWAY 421
Provider Second Line Business Practice Location Address:
11901 NORTH HWY 421
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962-4859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-598-2706
Provider Business Practice Location Address Fax Number:
606-598-0856
Provider Enumeration Date:
03/20/2006