Provider First Line Business Practice Location Address:
19 SOLOMON 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:
41858-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-4481
Provider Business Practice Location Address Fax Number:
606-633-0207
Provider Enumeration Date:
02/27/2007