Provider First Line Business Practice Location Address:
151 DORTON-JENKINS HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-639-2273
Provider Business Practice Location Address Fax Number:
606-639-2216
Provider Enumeration Date:
10/31/2006