Provider First Line Business Practice Location Address:
80 HOSPITAL DR
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:
40906-7363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-4175
Provider Business Practice Location Address Fax Number:
606-545-4863
Provider Enumeration Date:
10/28/2008