Provider First Line Business Practice Location Address:
HC 88 BOX 180
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUNLOCK
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41632-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-884-5124
Provider Business Practice Location Address Fax Number:
606-884-5000
Provider Enumeration Date:
11/29/2007