Provider First Line Business Practice Location Address:
9879 KY ROUTE 122
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC DOWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41647-6026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-377-3400
Provider Business Practice Location Address Fax Number:
606-377-3494
Provider Enumeration Date:
09/15/2006