Provider First Line Business Practice Location Address:
225 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAINTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41240-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-789-2590
Provider Business Practice Location Address Fax Number:
606-789-8888
Provider Enumeration Date:
06/10/2010