Provider First Line Business Practice Location Address:
135 E 1ST ST
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:
40351-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-517-4633
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2026