Provider First Line Business Practice Location Address:
276 JIM IRELAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARLOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42024-9706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-816-4401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2025