Provider First Line Business Practice Location Address:
105 S LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-4112
Provider Business Practice Location Address Fax Number:
606-546-8456
Provider Enumeration Date:
11/09/2016