Provider First Line Business Practice Location Address:
50 WEDDINGTON BRANCH RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-3296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-2172
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2007