Provider First Line Business Practice Location Address:
1197 AIRPORT RD
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:
41224-6500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-433-2400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2016