Provider First Line Business Practice Location Address:
334 FRAZIER ST
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:
37367-4926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-447-2149
Provider Business Practice Location Address Fax Number:
423-447-6777
Provider Enumeration Date:
01/31/2007