Provider First Line Business Practice Location Address:
104 E MAIN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INEZ
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41224-8928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-298-7633
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2019