Provider First Line Business Practice Location Address:
128 CARDINAL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALYERSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41465-9114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-349-2812
Provider Business Practice Location Address Fax Number:
606-349-1739
Provider Enumeration Date:
07/27/2006