Provider First Line Business Practice Location Address:
1814 CUMBERLAND AVENUE
Provider Second Line Business Practice Location Address:
MIDDLESBORO MANOR SHOPPING CENTER
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:
865-386-8454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2010