Provider First Line Business Practice Location Address:
115 E PUBLIC SQ STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-943-7818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2020