Provider First Line Business Practice Location Address:
1350 FLEMINGSBURG RD
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:
40351-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-263-5140
Provider Business Practice Location Address Fax Number:
859-263-5141
Provider Enumeration Date:
12/13/2006