Provider First Line Business Practice Location Address:
268 HWY 62
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARDWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42023-0367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-628-3512
Provider Business Practice Location Address Fax Number:
270-628-3513
Provider Enumeration Date:
07/26/2006