Provider First Line Business Practice Location Address:
175 THAD REDMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAYNEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40157-7524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-496-4435
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2020