Provider First Line Business Practice Location Address:
215 TREUHAFT BLVD
Provider Second Line Business Practice Location Address:
SUITE 3B
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-2773
Provider Business Practice Location Address Fax Number:
606-679-4626
Provider Enumeration Date:
09/08/2010