Provider First Line Business Practice Location Address:
2471 ELIZABETHTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEITCHFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42754-9119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-259-4008
Provider Business Practice Location Address Fax Number:
270-259-4009
Provider Enumeration Date:
11/22/2005