Provider First Line Business Practice Location Address:
6800 US HIGHWAY 23 S
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-639-1200
Provider Business Practice Location Address Fax Number:
606-639-1020
Provider Enumeration Date:
11/02/2012