Provider First Line Business Practice Location Address:
919 ELKHORN CREEK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHORN CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-865-5917
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2006