Provider First Line Business Practice Location Address:
3051 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37367-0150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-447-2134
Provider Business Practice Location Address Fax Number:
423-447-6330
Provider Enumeration Date:
12/05/2006