Provider First Line Business Practice Location Address:
249 LEFT FORK OF ISLAND CRK
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:
41501-7219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-471-4546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2023