Provider First Line Business Practice Location Address:
404 HARRISON 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:
41144-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-571-3478
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2009