Provider First Line Business Practice Location Address:
205 HARRISON ST
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:
41144-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-963-1574
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2024