Provider First Line Business Practice Location Address:
101 E GARNETTSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MULDRAUGH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40155-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-938-8691
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2008