Provider First Line Business Practice Location Address:
606 KNOX ST
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:
40906-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-627-9905
Provider Business Practice Location Address Fax Number:
606-277-0027
Provider Enumeration Date:
03/27/2014