Provider First Line Business Practice Location Address:
346 STATE ROUTE 58 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42031-9425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-236-2588
Provider Business Practice Location Address Fax Number:
270-236-9162
Provider Enumeration Date:
11/13/2010