Provider First Line Business Practice Location Address:
148 SUITE A
Provider Second Line Business Practice Location Address:
WHITESBURG PLAZA
Provider Business Practice Location Address City Name:
WHITESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-218-3500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2010