Provider First Line Business Practice Location Address:
9711 STATE HIGHWAY 194 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIMPER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41539-6232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-631-3327
Provider Business Practice Location Address Fax Number:
606-631-3320
Provider Enumeration Date:
04/12/2016