Provider First Line Business Practice Location Address:
119 E CLAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42031-1222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-415-7147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2020