Provider First Line Business Practice Location Address:
65 CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITLEY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42653-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-2224
Provider Business Practice Location Address Fax Number:
606-376-2205
Provider Enumeration Date:
12/11/2007