Provider First Line Business Practice Location Address:
401 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:
42261-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-779-3490
Provider Business Practice Location Address Fax Number:
270-526-6900
Provider Enumeration Date:
04/14/2014