Provider First Line Business Practice Location Address:
838 E MOUNTAIN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALYERSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-349-7475
Provider Business Practice Location Address Fax Number:
606-349-7476
Provider Enumeration Date:
08/25/2006