Provider First Line Business Practice Location Address:
1093 KY HIGHWAY 2022
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHORN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41721-8855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-438-4651
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2022