Provider First Line Business Practice Location Address:
997 ELIZAVILLE AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
FLEMINGSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41041-9210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-849-2626
Provider Business Practice Location Address Fax Number:
606-849-2634
Provider Enumeration Date:
09/21/2006