Provider First Line Business Practice Location Address:
9549 KY HWY 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:
41647-0700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-377-1088
Provider Business Practice Location Address Fax Number:
606-377-2626
Provider Enumeration Date:
11/20/2006