Provider First Line Business Practice Location Address:
221 3RD 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:
41240-1030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-226-1530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2012