Provider First Line Business Practice Location Address:
1121 S US HIGHWAY 25E
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:
40906-8005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-545-0539
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2015