Provider First Line Business Practice Location Address:
170 BEE FRK
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:
41653-7703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-339-6259
Provider Business Practice Location Address Fax Number:
606-339-6259
Provider Enumeration Date:
11/25/2025