Provider First Line Business Practice Location Address:
3600 W. CUMBERLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLESBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40965-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-242-1428
Provider Business Practice Location Address Fax Number:
606-248-1518
Provider Enumeration Date:
06/21/2006