Provider First Line Business Practice Location Address:
334 N LAKE DR
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:
41653-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-886-3030
Provider Business Practice Location Address Fax Number:
606-886-3040
Provider Enumeration Date:
08/18/2016