Provider First Line Business Practice Location Address:
125 NORTH MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40380-0278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-663-2520
Provider Business Practice Location Address Fax Number:
606-663-7662
Provider Enumeration Date:
04/11/2011