Provider First Line Business Practice Location Address:
419 TOWN MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SUITE 202 PROFESSIONAL ASSOCIATES BLDG
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-6162
Provider Business Practice Location Address Fax Number:
606-432-6142
Provider Enumeration Date:
07/29/2006