Provider First Line Business Practice Location Address:
PO BOX 221
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40823-0221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-733-0954
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2026