Provider First Line Business Practice Location Address:
255 OLD FLEMINGSBURG RD
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:
40351-1090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-783-1511
Provider Business Practice Location Address Fax Number:
606-783-0075
Provider Enumeration Date:
03/08/2007