Provider First Line Business Practice Location Address:
9465 US HIGHWAY 27 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40489-8852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-661-0277
Provider Business Practice Location Address Fax Number:
606-645-1776
Provider Enumeration Date:
12/03/2024