Provider First Line Business Practice Location Address:
221 W G L SMITH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42261-8602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-526-6800
Provider Business Practice Location Address Fax Number:
270-526-5462
Provider Enumeration Date:
06/09/2008