Provider First Line Business Practice Location Address:
9879 KENTUCKY ROUTE 122
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCDOWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41647-6042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-377-3427
Provider Business Practice Location Address Fax Number:
606-377-3369
Provider Enumeration Date:
09/11/2012