Provider First Line Business Practice Location Address:
6710 WOLF PEN BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRODS CREEK
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-228-6388
Provider Business Practice Location Address Fax Number:
502-897-6369
Provider Enumeration Date:
11/28/2006