Provider First Line Business Practice Location Address:
8340 U.S. 60 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-926-1229
Provider Business Practice Location Address Fax Number:
270-295-3716
Provider Enumeration Date:
04/17/2007