Provider First Line Business Practice Location Address:
304 WEST 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:
270-526-3346
Provider Business Practice Location Address Fax Number:
270-781-6129
Provider Enumeration Date:
04/17/2008