Provider First Line Business Practice Location Address:
190 HOWARD MARCUM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT SHERMAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-324-2850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2007