Provider First Line Business Practice Location Address:
1632 1/2 CUMBERLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
MIDDLESBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40965-1382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-337-6680
Provider Business Practice Location Address Fax Number:
606-337-1378
Provider Enumeration Date:
02/08/2006