Provider First Line Business Practice Location Address:
2864 HIGHWAY 119 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41858-8710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-312-1615
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2014