Provider First Line Business Practice Location Address:
3602 CUMBERLAND AVE
Provider Second Line Business Practice Location Address:
ARH PROFESSIONAL BUILDING
Provider Business Practice Location Address City Name:
MIDDLESBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40965-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-242-1330
Provider Business Practice Location Address Fax Number:
606-242-1337
Provider Enumeration Date:
08/18/2006