Provider First Line Business Practice Location Address:
102 MAIN ST.
Provider Second Line Business Practice Location Address:
PO BOX #2
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42159-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-745-9004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2024