Provider First Line Business Practice Location Address:
246 MINING CITY RD
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:
42261-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-999-3773
Provider Business Practice Location Address Fax Number:
270-526-6900
Provider Enumeration Date:
04/15/2016