Provider First Line Business Practice Location Address:
3604 CUMBERLAND 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:
40965-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-248-8282
Provider Business Practice Location Address Fax Number:
606-248-0030
Provider Enumeration Date:
10/15/2012