Provider First Line Business Practice Location Address:
14098 KY HIGHWAY 27 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-379-6646
Provider Business Practice Location Address Fax Number:
606-379-5707
Provider Enumeration Date:
08/06/2007