Provider First Line Business Practice Location Address:
RT 122, BOX 247
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:
41647-0578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-285-9234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2007