Provider First Line Business Practice Location Address:
1801 W. HWY. 90 BY-PASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-348-6034
Provider Business Practice Location Address Fax Number:
606-348-6521
Provider Enumeration Date:
11/15/2006