Provider First Line Business Practice Location Address:
3602 WEST CUMBERLAND AVE.,
Provider Second Line Business Practice Location Address:
STE. B-102
Provider Business Practice Location Address City Name:
MIDDLESBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-248-7778
Provider Business Practice Location Address Fax Number:
606-248-7787
Provider Enumeration Date:
12/06/2011