Provider First Line Business Practice Location Address:
400 UNIVERSITY DR STE 102B
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:
41653-1080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-506-5114
Provider Business Practice Location Address Fax Number:
606-506-5116
Provider Enumeration Date:
04/21/2016