Provider First Line Business Practice Location Address:
515 BROADWAY ST
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:
41240-1391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-422-3333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2024