Provider First Line Business Practice Location Address:
1271 BEAR TRACK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEATTYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-464-2058
Provider Business Practice Location Address Fax Number:
606-464-8347
Provider Enumeration Date:
10/20/2006