Provider First Line Business Practice Location Address:
730 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-784-8954
Provider Business Practice Location Address Fax Number:
606-784-1443
Provider Enumeration Date:
04/14/2011