Provider First Line Business Practice Location Address:
5000 KY ROUTE 321
Provider Second Line Business Practice Location Address:
SUITE 4102
Provider Business Practice Location Address City Name:
PRESTONSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41653-9113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-889-6210
Provider Business Practice Location Address Fax Number:
606-889-6291
Provider Enumeration Date:
11/11/2013