Provider First Line Business Practice Location Address:
1187 ALVIN YORK HWY
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:
37367-9294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-447-3554
Provider Business Practice Location Address Fax Number:
423-447-7596
Provider Enumeration Date:
04/26/2006