Provider First Line Business Practice Location Address:
286 US HIGHWAY 23 N
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:
41653-8732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-874-0032
Provider Business Practice Location Address Fax Number:
606-874-0064
Provider Enumeration Date:
05/17/2006