The route is a northern bypass to US 58 which stays closer to the Tennessee border and serves Gate City and Bristol.

heads east along two-lane Main Street, then north along the Trail of the Lonesome Pine to exit the town.

temporarily becomes undivided through Ben Hur, where the highway begins to parallel CSX's Cumberland Valley Subdivision rail line.

The highway drops to two lanes and crosses over the rail line as it enters the town of Pennington Gap.

The highway veers north to cross the mountain at Little Stone Gap, then curves back east again and enters the independent city of Norton.

and US 23 cross over SR 74, Norfolk Southern's Clinch Valley District rail line, and the Guest River before reaching the partial cloverleaf interchange where the highways diverge.

The highway leaves the city of Norton and re-enters Wise County at its junction with SR 74 (Kentucky Avenue).

The highway meets the eastern end of SR 158 at Banner, then continues southeast as Bull Run Road toward the town of St. Paul.

passes under the Clinch Valley District rail line and briefly cuts through a strip of Russell County, within which the highway intersects SR 63 (Wise Street).

The alternate route returns to Wise County as Castlewood Drive, crosses over CSX's Kingsport Subdivision, and meets the southern end of SR 270 (Fourth Street).

continues as Trail of the Lonesome Pine along the south and west side of the unincorporated community of Castlewood and meets the northern end of SR 65 at Banners Corner.

splits east onto two-lane Russell Road, which passes to the north of the William King Museum.

The highways cross over Norfolk Southern's Pulaski District rail line and head south a diamond interchange with I-81 and US 58 that serves as the eastern terminus of US 58 Alt.