Provider First Line Business Practice Location Address:
792 SOUTH HWY 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINDMAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-375-9395
Provider Business Practice Location Address Fax Number:
606-447-2299
Provider Enumeration Date:
05/27/2009