Provider First Line Business Practice Location Address:
230 STATE HIGHWAY 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLIVE HILL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41164-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-286-2035
Provider Business Practice Location Address Fax Number:
606-286-0156
Provider Enumeration Date:
07/21/2009