Provider First Line Business Practice Location Address:
12410 HANSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLAUGHTERS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42456-9604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-927-8585
Provider Business Practice Location Address Fax Number:
270-927-8911
Provider Enumeration Date:
07/27/2010