Provider First Line Business Practice Location Address:
1621 S HIGHWAY 421 STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962-7514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-731-2223
Provider Business Practice Location Address Fax Number:
606-731-2225
Provider Enumeration Date:
08/23/2017