Provider First Line Business Practice Location Address:
428 E MAIN ST
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:
41224-8931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-298-2660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2012