Provider First Line Business Practice Location Address:
156 ISLAND CREEK RD
Provider Second Line Business Practice Location Address:
PEDIATRIC ASSOCIATES
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-9340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-3221
Provider Business Practice Location Address Fax Number:
606-437-0438
Provider Enumeration Date:
10/24/2005