Provider First Line Business Practice Location Address:
17401 KENTUCKY HWY 80 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHORN CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41522-8210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-754-3131
Provider Business Practice Location Address Fax Number:
606-754-4554
Provider Enumeration Date:
11/20/2007