Provider First Line Business Practice Location Address:
19101 N US HIGHWAY 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40823-8107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-589-5421
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2017