Provider First Line Business Practice Location Address:
234 MEDICAL CIR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-1194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-784-6641
Provider Business Practice Location Address Fax Number:
606-780-2379
Provider Enumeration Date:
05/08/2013