Provider First Line Business Practice Location Address:
9788 KY ROUTE 122
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:
41647-6025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-377-3415
Provider Business Practice Location Address Fax Number:
606-377-3453
Provider Enumeration Date:
07/23/2007