Provider First Line Business Practice Location Address:
213 W. 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-526-2228
Provider Business Practice Location Address Fax Number:
270-526-2218
Provider Enumeration Date:
05/12/2006