Provider First Line Business Practice Location Address:
3538 HIGHWAY 160 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRINKLEY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41822-9061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-785-4744
Provider Business Practice Location Address Fax Number:
606-785-4663
Provider Enumeration Date:
11/30/2006