Provider First Line Business Practice Location Address:
1507 US HIGHWAY 25 E
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:
40965-1862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-248-3474
Provider Business Practice Location Address Fax Number:
606-248-3937
Provider Enumeration Date:
03/05/2007