Provider First Line Business Practice Location Address:
211 E G L SMITH ST
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:
42261-9413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-526-3877
Provider Business Practice Location Address Fax Number:
270-526-2929
Provider Enumeration Date:
10/10/2007