Provider First Line Business Practice Location Address:
415 NORTH LAKE DRIVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
PRESTONSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-886-4260
Provider Business Practice Location Address Fax Number:
606-886-0886
Provider Enumeration Date:
06/07/2006