Provider First Line Business Practice Location Address:
232 MAIN ST
Provider Second Line Business Practice Location Address:
FAMILY BANK BLD SUITE 206
Provider Business Practice Location Address City Name:
PAINTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41240-1040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-788-0406
Provider Business Practice Location Address Fax Number:
606-788-0496
Provider Enumeration Date:
01/22/2007