Provider First Line Business Practice Location Address:
97 TRIMBLE CHAPEL SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESTONSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41653-8461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-874-0240
Provider Business Practice Location Address Fax Number:
606-874-8666
Provider Enumeration Date:
03/15/2024