Provider First Line Business Practice Location Address:
14684 HIGHWAY 550 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACKEY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41643-9016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-946-2411
Provider Business Practice Location Address Fax Number:
606-946-2793
Provider Enumeration Date:
03/31/2016