Provider First Line Business Practice Location Address:
284 TOWN MOUNTAIN RD
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:
606-432-5588
Provider Business Practice Location Address Fax Number:
606-432-0983
Provider Enumeration Date:
11/02/2006