Provider First Line Business Practice Location Address:
3086 MAIN ST.
Provider Second Line Business Practice Location Address:
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:
423-447-2421
Provider Business Practice Location Address Fax Number:
423-447-3408
Provider Enumeration Date:
09/22/2010