Provider First Line Business Practice Location Address:
125 W 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:
40965-2881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-248-5322
Provider Business Practice Location Address Fax Number:
606-248-9244
Provider Enumeration Date:
02/18/2014