Provider First Line Business Practice Location Address:
547A W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-1539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-780-7400
Provider Business Practice Location Address Fax Number:
606-783-7400
Provider Enumeration Date:
11/16/2010