Provider First Line Business Practice Location Address:
504 CHINNS BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WURTLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41144-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-836-2096
Provider Business Practice Location Address Fax Number:
606-326-0764
Provider Enumeration Date:
12/07/2010