Provider First Line Business Practice Location Address:
315 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-7917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-6624
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2007