Provider First Line Business Practice Location Address:
1027 HIGHWAY 11 N
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:
41311-9240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-464-0061
Provider Business Practice Location Address Fax Number:
606-464-0420
Provider Enumeration Date:
12/12/2012