Provider First Line Business Practice Location Address:
119 W OHIO ST
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42261-8417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-202-4639
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2023