Provider First Line Business Practice Location Address:
5080 KY ROUTE 321 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESTONSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41653-9160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-889-6310
Provider Business Practice Location Address Fax Number:
606-889-6314
Provider Enumeration Date:
10/07/2019