Provider First Line Business Practice Location Address:
9847 ELIZABETHTOWN RD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
BIG CLIFTY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42712-5880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-242-4344
Provider Business Practice Location Address Fax Number:
844-607-4506
Provider Enumeration Date:
05/21/2008