Provider First Line Business Practice Location Address:
PO BOX 341
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-0341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-627-3592
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2026