Provider First Line Business Practice Location Address:
5401 HIGHWAY 7 N
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:
41858-8299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-0056
Provider Business Practice Location Address Fax Number:
606-633-0562
Provider Enumeration Date:
07/15/2009