Provider First Line Business Practice Location Address:
646 MANCHESTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-545-6055
Provider Business Practice Location Address Fax Number:
606-545-6045
Provider Enumeration Date:
06/10/2008