Provider First Line Business Practice Location Address:
RTE 40 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INEZ
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41224-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-298-3589
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2006