Provider First Line Business Practice Location Address:
5571 COLLINS HIGHWAY
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:
41502-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-639-4588
Provider Business Practice Location Address Fax Number:
606-639-3197
Provider Enumeration Date:
01/08/2009