Provider First Line Business Practice Location Address:
ROUTE 40 EAST
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:
41224-0366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-298-3572
Provider Business Practice Location Address Fax Number:
606-298-4427
Provider Enumeration Date:
01/16/2007