Provider First Line Business Practice Location Address:
71 WHEELERTOWN AVENUE
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:
37367-0699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-778-4780
Provider Business Practice Location Address Fax Number:
423-778-4833
Provider Enumeration Date:
10/04/2006