Provider First Line Business Practice Location Address:
9575 KY HWY 122
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
MCDOWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41647-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-949-1623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2014