Provider First Line Business Practice Location Address:
14 KNOX PLZ
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:
40906-7300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-545-2908
Provider Business Practice Location Address Fax Number:
606-401-0061
Provider Enumeration Date:
06/30/2021