Provider First Line Business Practice Location Address:
205 E OHIO 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:
42261-7944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-526-2772
Provider Business Practice Location Address Fax Number:
270-526-6323
Provider Enumeration Date:
08/23/2006