Provider First Line Business Practice Location Address:
5401 HIGHWAY 7 N
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:
41858-8299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-8883
Provider Business Practice Location Address Fax Number:
606-633-8885
Provider Enumeration Date:
03/11/2010