Provider First Line Business Practice Location Address:
HC 62 BOX 1590
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALYERSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41465-9222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-349-2847
Provider Business Practice Location Address Fax Number:
606-349-6466
Provider Enumeration Date:
11/28/2007