Provider First Line Business Practice Location Address:
2110 OLD CUBA ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUBANK
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-733-2733
Provider Business Practice Location Address Fax Number:
877-313-1501
Provider Enumeration Date:
01/20/2026