Provider First Line Business Practice Location Address:
83 STATE ROUTE 271 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWESVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42348-6809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-927-6914
Provider Business Practice Location Address Fax Number:
270-927-6916
Provider Enumeration Date:
02/21/2007