Provider First Line Business Practice Location Address:
13279 HWY 119 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARTRIDGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40862-6417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-589-5930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2005