Provider First Line Business Practice Location Address:
61 COURT HOUSE SQUARE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITLEY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42653-0061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-5882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2009