Provider First Line Business Practice Location Address:
1380 HIGHWAY 192 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40741-3123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-330-0050
Provider Business Practice Location Address Fax Number:
606-330-0029
Provider Enumeration Date:
06/22/2005