Provider First Line Business Practice Location Address:
101 LEGION DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CENTRAL CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42330-1496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-754-7227
Provider Business Practice Location Address Fax Number:
270-754-7230
Provider Enumeration Date:
10/18/2012