Provider First Line Business Practice Location Address:
1230 POPE TRAMMEL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164-8746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-943-0640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2012