Provider First Line Business Practice Location Address:
12659 US HIGHWAY 27 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERRY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41003-9022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-234-5333
Provider Business Practice Location Address Fax Number:
859-234-9162
Provider Enumeration Date:
01/22/2007