Provider First Line Business Practice Location Address:
210 N 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:
42261-7919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-526-3137
Provider Business Practice Location Address Fax Number:
270-526-4829
Provider Enumeration Date:
09/16/2009