Provider First Line Business Practice Location Address:
80 HOSPITAL DR STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-7363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-545-4460
Provider Business Practice Location Address Fax Number:
606-545-4469
Provider Enumeration Date:
07/31/2006