Provider First Line Business Practice Location Address:
433 GEORGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETSY LAYNE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41605-7013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-478-5454
Provider Business Practice Location Address Fax Number:
606-478-5454
Provider Enumeration Date:
05/05/2006