Provider First Line Business Practice Location Address:
101 SOUTH DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAVE CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-773-2252
Provider Business Practice Location Address Fax Number:
270-773-2236
Provider Enumeration Date:
06/15/2006