Provider First Line Business Practice Location Address:
1900 N HWY 27
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITLEY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42653-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-5391
Provider Business Practice Location Address Fax Number:
606-376-3326
Provider Enumeration Date:
09/24/2012