Provider First Line Business Practice Location Address:
205 WEST G L SMITH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-526-5615
Provider Business Practice Location Address Fax Number:
270-526-6713
Provider Enumeration Date:
04/13/2011