Provider First Line Business Practice Location Address:
750 W. MAIN STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-783-0182
Provider Business Practice Location Address Fax Number:
606-783-0272
Provider Enumeration Date:
05/13/2010