Provider First Line Business Practice Location Address:
1732 VETERANS MEMORIAL HWY
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:
42164-6327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-796-7768
Provider Business Practice Location Address Fax Number:
270-618-6678
Provider Enumeration Date:
02/03/2014