Provider First Line Business Practice Location Address:
113 N. WINTER ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40347-0761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-846-4940
Provider Business Practice Location Address Fax Number:
859-846-4237
Provider Enumeration Date:
01/29/2013