Provider First Line Business Practice Location Address:
110 E LOTHBURY AVE
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:
40965-2846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-248-1938
Provider Business Practice Location Address Fax Number:
606-248-1923
Provider Enumeration Date:
01/25/2006