Provider First Line Business Practice Location Address:
283 GOBLE ST
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:
41653-7967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-886-2788
Provider Business Practice Location Address Fax Number:
606-886-7989
Provider Enumeration Date:
01/03/2019