Provider First Line Business Practice Location Address:
732 HIGHWAY 36
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCHBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40322-8123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-768-2191
Provider Business Practice Location Address Fax Number:
606-768-6130
Provider Enumeration Date:
05/13/2021