Provider First Line Business Practice Location Address:
533 HAMBLEY BLVD
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-437-0207
Provider Business Practice Location Address Fax Number:
606-432-2737
Provider Enumeration Date:
05/19/2006