Provider First Line Business Practice Location Address:
28564 US 23 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH SHORE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41175-7927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-498-4079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2018