Provider First Line Business Practice Location Address:
4963 US HWY 23 N
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
IVEL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-653-1505
Provider Business Practice Location Address Fax Number:
606-657-0354
Provider Enumeration Date:
03/23/2015