Provider First Line Business Practice Location Address:
6905 HWY 550 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINDMAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-946-2977
Provider Business Practice Location Address Fax Number:
606-946-2925
Provider Enumeration Date:
01/16/2008