Provider First Line Business Practice Location Address:
1019 W MAIN ST
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-780-0002
Provider Business Practice Location Address Fax Number:
606-780-0024
Provider Enumeration Date:
11/22/2006