Provider First Line Business Practice Location Address:
142 SPENCER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40312-9722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-481-8017
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2023