Provider First Line Business Practice Location Address:
2307 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40823-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-589-2234
Provider Business Practice Location Address Fax Number:
606-589-4610
Provider Enumeration Date:
07/18/2017