Provider First Line Business Practice Location Address:
5330 LAYTHAM PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYS LICK
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-763-6255
Provider Business Practice Location Address Fax Number:
800-584-1465
Provider Enumeration Date:
08/20/2008