Provider First Line Business Practice Location Address:
538 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAINTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-226-6667
Provider Business Practice Location Address Fax Number:
606-789-3811
Provider Enumeration Date:
06/14/2006