Provider First Line Business Practice Location Address:
60 JENKINS RD
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:
41858-7601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-7000
Provider Business Practice Location Address Fax Number:
606-633-7000
Provider Enumeration Date:
09/17/2010