Provider First Line Business Practice Location Address:
125 S LIBERTY 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:
40906-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-4985
Provider Business Practice Location Address Fax Number:
606-546-4965
Provider Enumeration Date:
11/02/2006