Provider First Line Business Practice Location Address:
88 CHURCH RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
HAROLD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41635-9016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-478-9333
Provider Business Practice Location Address Fax Number:
606-478-9333
Provider Enumeration Date:
07/12/2005