Provider First Line Business Practice Location Address:
68 CARMICHAEL DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40312-0012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-663-3421
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2007