Provider First Line Business Practice Location Address:
176 12TH ST
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:
40312-8981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-663-9011
Provider Business Practice Location Address Fax Number:
606-663-9012
Provider Enumeration Date:
09/07/2011