Provider First Line Business Practice Location Address:
5230 KY ROUTE 321
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PRESTONSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41653-9168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-318-8685
Provider Business Practice Location Address Fax Number:
781-318-8689
Provider Enumeration Date:
10/07/2009