Provider First Line Business Practice Location Address:
49 SOUTH CHURCH STREET
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:
41465-0068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-349-3135
Provider Business Practice Location Address Fax Number:
606-349-3512
Provider Enumeration Date:
03/14/2008