Provider First Line Business Practice Location Address:
236 WILSON BRANCH RD
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:
40906-7140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-909-0044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2026