Provider First Line Business Practice Location Address:
604 JAMES S TRIMBLE BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PAINTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-788-0303
Provider Business Practice Location Address Fax Number:
606-788-0310
Provider Enumeration Date:
09/22/2015