Provider First Line Business Practice Location Address:
7151 STATE ROUTE 2
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:
41144-7861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-922-2895
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2026