Provider First Line Business Practice Location Address:
95 STONECOAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARRETT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-358-9135
Provider Business Practice Location Address Fax Number:
606-358-0005
Provider Enumeration Date:
12/12/2006