Provider First Line Business Practice Location Address:
439 ALLEN P. DEAKINS ROAD
Provider Second Line Business Practice Location Address:
PO 673
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-447-2590
Provider Business Practice Location Address Fax Number:
423-447-7351
Provider Enumeration Date:
06/22/2009