Provider First Line Business Practice Location Address:
1530 US HIGHWAY 25 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLESBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40965-1861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-654-9450
Provider Business Practice Location Address Fax Number:
606-302-4240
Provider Enumeration Date:
01/30/2020