Provider First Line Business Practice Location Address:
4644 HIGHWAY 15 WEST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-663-3481
Provider Business Practice Location Address Fax Number:
606-663-4235
Provider Enumeration Date:
06/27/2006