Provider First Line Business Practice Location Address:
HC 61 BOX 535
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:
41465-0535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-349-7710
Provider Business Practice Location Address Fax Number:
606-349-7720
Provider Enumeration Date:
05/18/2006