Provider First Line Business Practice Location Address:
31 E HARRIS ST
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:
41653-7834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-230-0951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2006