Provider First Line Business Practice Location Address:
881 KY ROUTE 689 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLATGAP
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41219-9546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-265-8891
Provider Business Practice Location Address Fax Number:
606-265-4409
Provider Enumeration Date:
01/17/2018