Provider First Line Business Practice Location Address:
130 NEWTOWNE SQ
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:
40351-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-740-0986
Provider Business Practice Location Address Fax Number:
606-780-9096
Provider Enumeration Date:
03/15/2023