Provider First Line Business Practice Location Address:
60 SLATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40360-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-674-6979
Provider Business Practice Location Address Fax Number:
606-674-2637
Provider Enumeration Date:
03/30/2006