Provider First Line Business Practice Location Address:
664 SLATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-329-8588
Provider Business Practice Location Address Fax Number:
606-329-8195
Provider Enumeration Date:
03/11/2016