Provider First Line Business Practice Location Address:
84 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WHITESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41858-7254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-0035
Provider Business Practice Location Address Fax Number:
606-633-0035
Provider Enumeration Date:
04/09/2012