Provider First Line Business Practice Location Address:
911 SOUTH BY PASS ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-1357
Provider Business Practice Location Address Fax Number:
606-432-2457
Provider Enumeration Date:
08/29/2006