Provider First Line Business Practice Location Address:
415 WEST SUN STREET
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:
606-784-8928
Provider Business Practice Location Address Fax Number:
606-783-1011
Provider Enumeration Date:
03/26/2007