Provider First Line Business Practice Location Address:
315 HOSPITAL DR
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-545-6491
Provider Business Practice Location Address Fax Number:
606-545-0342
Provider Enumeration Date:
08/30/2006