Provider First Line Business Practice Location Address:
9549 KY RT 122
Provider Second Line Business Practice Location Address:
ADDRESS LINE 2
Provider Business Practice Location Address City Name:
MCDOWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41647
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:
02/04/2021