Provider First Line Business Practice Location Address:
401 US 23
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:
41144-1074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-473-1501
Provider Business Practice Location Address Fax Number:
606-473-1503
Provider Enumeration Date:
10/12/2006