Provider First Line Business Practice Location Address:
2612 KING KELLY COLEMAN HWY.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-284-2009
Provider Business Practice Location Address Fax Number:
833-623-3078
Provider Enumeration Date:
10/03/2023