Provider First Line Business Practice Location Address:
76 MEDICAL LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITLEY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-825-0000
Provider Business Practice Location Address Fax Number:
606-825-0024
Provider Enumeration Date:
07/10/2015