Provider First Line Business Practice Location Address:
4160 S HWY 27
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE KNOT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-354-2222
Provider Business Practice Location Address Fax Number:
606-354-3830
Provider Enumeration Date:
10/29/2010