Provider First Line Business Practice Location Address:
ROUTE 1 BOX 1005
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLLESBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-798-2072
Provider Business Practice Location Address Fax Number:
606-798-2222
Provider Enumeration Date:
11/08/2006