Provider First Line Business Practice Location Address:
PO BOX 2748
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:
41502-2748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-3221
Provider Business Practice Location Address Fax Number:
606-432-4931
Provider Enumeration Date:
11/19/2025