Provider First Line Business Practice Location Address:
1015 S MAIN 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:
42261-9432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-662-0045
Provider Business Practice Location Address Fax Number:
270-662-0053
Provider Enumeration Date:
02/02/2007