Provider First Line Business Practice Location Address:
1370 S DIXIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HORSE CAVE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42749-1285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-786-2997
Provider Business Practice Location Address Fax Number:
270-786-2997
Provider Enumeration Date:
02/05/2006