Organization
COMMONWEALTH QUALITY MEDICAL MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN JUSTICE (CO-OWNER)
(606) 769-6824
Entity
Organization
Contact information
Practice address
387 EDGEWOOD LN, PRESTONSBURG, KY 41653-9196
(606) 769-6824
(606) 769-0086
Mailing address
PO BOX 1747, PRESTONSBURG, KY 41653-5747
(606) 769-6824
(606) 769-0086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/17/2010
Last updated
11/17/2010
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