Provider First Line Business Practice Location Address:
221 GASKIN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42629-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-354-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2013