Provider First Line Business Practice Location Address:
4157 STATE ROUTE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARGILLITE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41121-8358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-408-8921
Provider Business Practice Location Address Fax Number:
606-408-8908
Provider Enumeration Date:
03/02/2020