Provider First Line Business Practice Location Address:
428 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAINTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-789-5846
Provider Business Practice Location Address Fax Number:
606-789-5876
Provider Enumeration Date:
05/19/2006