Provider First Line Business Practice Location Address:
1118 S MAIN ST STE 2
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:
42261-9409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-288-5036
Provider Business Practice Location Address Fax Number:
270-228-5082
Provider Enumeration Date:
07/30/2020