Provider First Line Business Practice Location Address:
1777 US HIGHWAY 60 W TRLR 4
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:
40351-8938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-316-0428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2020