Provider First Line Business Practice Location Address:
214 HOSPITAL RD STE A
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:
41858-7627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-2256
Provider Business Practice Location Address Fax Number:
606-633-3814
Provider Enumeration Date:
08/07/2006