Provider First Line Business Practice Location Address:
206 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-784-4491
Provider Business Practice Location Address Fax Number:
606-780-0872
Provider Enumeration Date:
10/14/2016