Provider First Line Business Practice Location Address:
64 KIRK PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INEZ
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41224-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-298-7768
Provider Business Practice Location Address Fax Number:
606-298-4839
Provider Enumeration Date:
12/12/2007