Provider First Line Business Practice Location Address:
1071 HWY 11 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEATTYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-867-1840
Provider Business Practice Location Address Fax Number:
800-867-1841
Provider Enumeration Date:
02/18/2021