Provider First Line Business Practice Location Address:
1801 ELIZABETHTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEITCHFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42754-9138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-259-9384
Provider Business Practice Location Address Fax Number:
270-259-0814
Provider Enumeration Date:
10/27/2020