Provider First Line Business Practice Location Address:
316 W 2ND 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:
40351-1550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-783-7701
Provider Business Practice Location Address Fax Number:
606-784-3701
Provider Enumeration Date:
09/22/2005