Provider First Line Business Practice Location Address:
814 HIGHWAY 36
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCHBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-393-0953
Provider Business Practice Location Address Fax Number:
606-393-0953
Provider Enumeration Date:
12/28/2016