Provider First Line Business Practice Location Address:
29 HENDERSON SETTLEMENT LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAKES
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-337-2921
Provider Business Practice Location Address Fax Number:
606-526-8606
Provider Enumeration Date:
06/06/2017