Provider First Line Business Practice Location Address:
224 PARKS 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:
41858-7538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-4455
Provider Business Practice Location Address Fax Number:
606-633-4724
Provider Enumeration Date:
02/07/2007