Provider First Line Business Practice Location Address:
217 8TH 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:
41240-1284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-792-2469
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2006