Provider First Line Business Practice Location Address:
110 CAREY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-329-8588
Provider Business Practice Location Address Fax Number:
606-329-8195
Provider Enumeration Date:
01/07/2016