Provider First Line Business Practice Location Address:
3602 WEST CUMBERLAND AVENUE
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:
40965-0340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-242-1463
Provider Business Practice Location Address Fax Number:
606-242-1111
Provider Enumeration Date:
09/01/2006