Provider First Line Business Practice Location Address:
1632 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:
40965-1378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-242-2196
Provider Business Practice Location Address Fax Number:
606-242-2586
Provider Enumeration Date:
03/18/2008