Provider First Line Business Practice Location Address:
326 HOSPITAL 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:
41858-7627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-3503
Provider Business Practice Location Address Fax Number:
606-633-3586
Provider Enumeration Date:
12/19/2005