Provider First Line Business Practice Location Address:
636 KY ROUTE 993
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:
41240-8576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-791-2024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2022