Provider First Line Business Practice Location Address:
167 WEDDINGTON BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-4477
Provider Business Practice Location Address Fax Number:
606-432-4201
Provider Enumeration Date:
03/28/2006