Provider First Line Business Practice Location Address:
118 CLAY CO S/C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-599-0209
Provider Business Practice Location Address Fax Number:
606-599-0279
Provider Enumeration Date:
12/03/2012