Provider First Line Business Practice Location Address:
1615 ASHLAND RD
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:
41144-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-831-1129
Provider Business Practice Location Address Fax Number:
606-473-7174
Provider Enumeration Date:
07/06/2006