Provider First Line Business Practice Location Address:
726 S US HWY 25 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-0310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-3464
Provider Business Practice Location Address Fax Number:
606-546-4579
Provider Enumeration Date:
01/30/2007