Provider First Line Business Practice Location Address:
71 MEDICAL LANE
Provider Second Line Business Practice Location Address:
SOUTH FORK MEDICAL CLINIC
Provider Business Practice Location Address City Name:
WHITLEY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42653-0071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-376-7212
Provider Business Practice Location Address Fax Number:
606-376-7216
Provider Enumeration Date:
06/07/2006