Provider First Line Business Practice Location Address:
425 CLINIC DR
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:
40351-1077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-784-7551
Provider Business Practice Location Address Fax Number:
606-780-2373
Provider Enumeration Date:
07/24/2006