Provider First Line Business Practice Location Address:
246 MEDICAL PLAZA LN
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WHITESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41858-7425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-1335
Provider Business Practice Location Address Fax Number:
606-633-1339
Provider Enumeration Date:
06/01/2006