Provider First Line Business Practice Location Address:
165 HALLS BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40380-8033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-663-0114
Provider Business Practice Location Address Fax Number:
606-663-0114
Provider Enumeration Date:
10/15/2008