Provider First Line Business Practice Location Address:
219 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENUP
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41144-1068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-473-6322
Provider Business Practice Location Address Fax Number:
606-473-0200
Provider Enumeration Date:
02/14/2007