Provider First Line Business Practice Location Address:
146 CHURCH OF CHRIST WAY
Provider Second Line Business Practice Location Address:
FORDS BRANCH CHURCH OF CRIST
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-8944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-213-7830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2011