Provider First Line Business Practice Location Address:
625 JAMES TRIMBLE BLVD
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:
606-789-3511
Provider Business Practice Location Address Fax Number:
606-789-1432
Provider Enumeration Date:
10/26/2005