Provider First Line Business Practice Location Address:
42 W PLEASANT POINT SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40489-9621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-510-4040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2021