Provider First Line Business Practice Location Address:
529 CAPP HARLAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42167-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-487-9231
Provider Business Practice Location Address Fax Number:
270-487-5784
Provider Enumeration Date:
03/18/2019