Provider First Line Business Practice Location Address:
911 BYPASS RD BLDG A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-1689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-430-2202
Provider Business Practice Location Address Fax Number:
606-218-7502
Provider Enumeration Date:
05/25/2012