Provider First Line Business Practice Location Address:
242 LEE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEATTYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41311-0668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-464-5000
Provider Business Practice Location Address Fax Number:
606-464-5009
Provider Enumeration Date:
01/02/2007