Provider First Line Business Practice Location Address:
6820 KY HIGHWAY 643
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRAB ORCHARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40419-8936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-749-5845
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2021