Provider First Line Business Practice Location Address:
4671 SOUTH CUMBERLAND GAP PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIMBLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-545-9478
Provider Business Practice Location Address Fax Number:
606-546-3903
Provider Enumeration Date:
05/12/2011