Provider First Line Business Practice Location Address:
657 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARPSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-481-4209
Provider Business Practice Location Address Fax Number:
859-966-2589
Provider Enumeration Date:
03/15/2011