Provider First Line Business Practice Location Address:
3470 HIGHWAY 80 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMALENA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41740-8854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-785-9377
Provider Business Practice Location Address Fax Number:
606-785-9371
Provider Enumeration Date:
03/06/2015