Provider First Line Business Practice Location Address:
140 VETERANS MEMORIAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-664-2526
Provider Business Practice Location Address Fax Number:
270-664-6082
Provider Enumeration Date:
10/28/2024