Provider First Line Business Practice Location Address:
220 NORTH 20TH ST
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:
40965-0959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-242-8800
Provider Business Practice Location Address Fax Number:
606-242-8805
Provider Enumeration Date:
01/08/2007