Provider First Line Business Practice Location Address:
KY HWY 122
Provider Second Line Business Practice Location Address:
SUITE 9521
Provider Business Practice Location Address City Name:
MC DOWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41647-0291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-377-2001
Provider Business Practice Location Address Fax Number:
606-377-6424
Provider Enumeration Date:
12/11/2006