Provider First Line Business Practice Location Address:
359 WYNN FLAT RD RM 121
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCHBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40322-7807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-768-9190
Provider Business Practice Location Address Fax Number:
606-768-9180
Provider Enumeration Date:
12/28/2015