Provider First Line Business Practice Location Address:
8070 US HIGHWAY 60 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42351-7087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-295-3777
Provider Business Practice Location Address Fax Number:
855-625-0821
Provider Enumeration Date:
11/06/2019