Provider First Line Business Practice Location Address:
123 N. 19TH ST.
Provider Second Line Business Practice Location Address:
123 N. 19TH ST.
Provider Business Practice Location Address City Name:
MIDDLESBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40965-4623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-248-3171
Provider Business Practice Location Address Fax Number:
606-248-3206
Provider Enumeration Date:
06/28/2006