Provider First Line Business Practice Location Address:
440 WASHINGTON 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:
40380-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-663-5771
Provider Business Practice Location Address Fax Number:
606-663-5650
Provider Enumeration Date:
02/12/2006