Provider First Line Business Practice Location Address:
153 JOHNSON RD.
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-377-2379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2007