Provider First Line Business Practice Location Address:
46 PROCTOR HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEATTYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41311-7445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-595-8489
Provider Business Practice Location Address Fax Number:
606-464-3974
Provider Enumeration Date:
04/04/2008