Provider First Line Business Practice Location Address:
348 KY ROUTE 3188
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANGLEY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41645-8910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-226-6892
Provider Business Practice Location Address Fax Number:
606-769-0868
Provider Enumeration Date:
01/08/2007