Provider First Line Business Practice Location Address: 
245 FLEMINGSBURG RD
    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: 
606-780-5500
    Provider Business Practice Location Address Fax Number: 
606-783-7281
    Provider Enumeration Date: 
07/24/2006