Provider First Line Business Practice Location Address:
147 HOMESTEAD COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-622-3777
Provider Business Practice Location Address Fax Number:
270-622-3445
Provider Enumeration Date:
11/15/2006