Provider First Line Business Practice Location Address:
9788 KY RT 122
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
MC DOWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41647-6042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-377-2492
Provider Business Practice Location Address Fax Number:
606-377-1018
Provider Enumeration Date:
08/31/2006