Provider First Line Business Practice Location Address:
9350 US HIGHWAY 23 SOUTH SUITE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-478-3636
Provider Business Practice Location Address Fax Number:
606-478-3635
Provider Enumeration Date:
07/06/2009