Provider First Line Business Practice Location Address:
123 WEST HWY 221
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLEDSOE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-3700
Provider Business Practice Location Address Fax Number:
606-573-6128
Provider Enumeration Date:
05/14/2013