Provider First Line Business Practice Location Address:
202 S COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164-1263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-237-5402
Provider Business Practice Location Address Fax Number:
270-237-4035
Provider Enumeration Date:
09/17/2018