Provider First Line Business Practice Location Address:
5291 KY RTE 321
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESTONSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-889-9003
Provider Business Practice Location Address Fax Number:
606-889-9404
Provider Enumeration Date:
10/20/2009