Provider First Line Business Practice Location Address:
28 RAILROAD STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BEATTYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-464-9688
Provider Business Practice Location Address Fax Number:
606-464-9687
Provider Enumeration Date:
01/25/2010