Provider First Line Business Practice Location Address:
1957 S. US HIGHWAY 25 E. STE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-545-7406
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2006