Provider First Line Business Practice Location Address:
290 E COURT 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:
41653-7932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-263-4714
Provider Business Practice Location Address Fax Number:
606-263-4712
Provider Enumeration Date:
04/26/2016