Provider First Line Business Practice Location Address:
829 JEFFERSON AVE
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:
41240-1355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-887-0742
Provider Business Practice Location Address Fax Number:
513-332-9072
Provider Enumeration Date:
05/16/2022