Provider First Line Business Practice Location Address:
400 MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEITCHFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42754-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-259-0352
Provider Business Practice Location Address Fax Number:
270-287-0157
Provider Enumeration Date:
06/10/2010