Provider First Line Business Practice Location Address:
9575 KY HWY 122, SUITE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCDOWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-949-1623
Provider Business Practice Location Address Fax Number:
859-800-9913
Provider Enumeration Date:
07/21/2020