Provider First Line Business Practice Location Address:
85 HIGHWAY 80
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:
40962-8801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-596-0410
Provider Business Practice Location Address Fax Number:
606-528-8272
Provider Enumeration Date:
12/13/2013