Provider First Line Business Practice Location Address:
231 WHITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-598-2219
Provider Business Practice Location Address Fax Number:
606-598-7972
Provider Enumeration Date:
01/16/2008