Provider First Line Business Practice Location Address:
147 N HIGHLAND AVE
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:
41653-7748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-753-6622
Provider Business Practice Location Address Fax Number:
502-262-2887
Provider Enumeration Date:
03/16/2021