Provider First Line Business Practice Location Address:
110 NORTH 11TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-248-7689
Provider Business Practice Location Address Fax Number:
606-242-3079
Provider Enumeration Date:
07/15/2006