Provider First Line Business Practice Location Address:
215 N ALLISON AVE
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:
40906-1336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-9287
Provider Business Practice Location Address Fax Number:
606-546-0009
Provider Enumeration Date:
06/11/2012