Provider First Line Business Practice Location Address:
1884 KY HIGHWAY 1284 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERRY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41003-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-369-3860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2026