Provider First Line Business Practice Location Address:
217 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-239-9355
Provider Business Practice Location Address Fax Number:
270-239-9356
Provider Enumeration Date:
11/14/2005