Provider First Line Business Practice Location Address:
179 HALE BRANCH RD
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:
40915-6166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-627-2941
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2023