Provider First Line Business Practice Location Address:
9575 KY ROUTE 122 STE 7
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:
41647-6043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-359-0700
Provider Business Practice Location Address Fax Number:
606-062-9318
Provider Enumeration Date:
03/11/2026