Provider First Line Business Practice Location Address:
1520 E MAIN ST
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:
40823-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-671-0024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2022