Provider First Line Business Practice Location Address:
2643 KING KELLY COLEMAN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-230-2255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2012