Provider First Line Business Practice Location Address:
1025 EUCLID AVE
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:
41240-8645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-789-5808
Provider Business Practice Location Address Fax Number:
606-789-6412
Provider Enumeration Date:
09/24/2012