Provider First Line Business Practice Location Address:
1201 EMMA KAYE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENUP
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41144-9304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-922-5512
Provider Business Practice Location Address Fax Number:
606-473-5667
Provider Enumeration Date:
06/15/2026