Provider First Line Business Practice Location Address:
180 TOWN MOUNTAIN RD STE 111
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:
41501-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-509-8633
Provider Business Practice Location Address Fax Number:
606-509-8634
Provider Enumeration Date:
12/20/2012