Provider First Line Business Practice Location Address:
1928 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:
40965-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-248-1052
Provider Business Practice Location Address Fax Number:
606-248-6598
Provider Enumeration Date:
07/19/2005