Provider First Line Business Practice Location Address:
60 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41858-7318
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:
606-218-4560
Provider Enumeration Date:
11/18/2005