Provider First Line Business Practice Location Address:
56 ATKINSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40380-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-663-4116
Provider Business Practice Location Address Fax Number:
606-663-4102
Provider Enumeration Date:
07/14/2005