Provider First Line Business Practice Location Address:
8525 US HIGHWAY 60 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42351-7214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-295-3356
Provider Business Practice Location Address Fax Number:
270-295-3055
Provider Enumeration Date:
07/06/2012