Provider First Line Business Practice Location Address:
94 BOARDWALK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INEZ
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41224-7003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-298-2080
Provider Business Practice Location Address Fax Number:
606-298-2081
Provider Enumeration Date:
01/18/2021