Provider First Line Business Practice Location Address:
1881 S US HIGHWAY 25E
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:
40906-7747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-545-0400
Provider Business Practice Location Address Fax Number:
606-545-0433
Provider Enumeration Date:
04/04/2008