Provider First Line Business Practice Location Address:
10897 S HIGHWAY 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCUDDY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41760-9033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-476-2333
Provider Business Practice Location Address Fax Number:
606-476-2082
Provider Enumeration Date:
09/30/2011