Provider First Line Business Practice Location Address:
215 TREUHAFT BLVD
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-7361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-271-0055
Provider Business Practice Location Address Fax Number:
706-270-0487
Provider Enumeration Date:
03/05/2013