Provider First Line Business Practice Location Address:
602 WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENUP
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41144-1053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-232-2067
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2013