Provider First Line Business Practice Location Address:
4326 N HWY 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARPSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-247-2621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2007