Provider First Line Business Practice Location Address:
209 DEPOT RD
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:
41240-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-886-9845
Provider Business Practice Location Address Fax Number:
606-886-0834
Provider Enumeration Date:
02/08/2007