Provider First Line Business Practice Location Address:
28350 U.S. 23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH SHORE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-932-2414
Provider Business Practice Location Address Fax Number:
606-932-2421
Provider Enumeration Date:
05/24/2007