Provider First Line Business Practice Location Address:
12975 HIGHWAY 421
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOSKINSTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40844-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-374-3641
Provider Business Practice Location Address Fax Number:
606-526-8606
Provider Enumeration Date:
06/26/2017