Provider First Line Business Practice Location Address:
6868 HIGHWAY 7 N
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:
41858-8113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-7812
Provider Business Practice Location Address Fax Number:
606-633-5731
Provider Enumeration Date:
05/09/2007