Provider First Line Business Practice Location Address:
2050 HIGHWAY 11 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-593-0382
Provider Business Practice Location Address Fax Number:
606-593-0384
Provider Enumeration Date:
11/03/2006