Provider First Line Business Practice Location Address:
129 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41601-9422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-874-2800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2026