Provider First Line Business Practice Location Address:
214 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-633-8228
Provider Business Practice Location Address Fax Number:
304-962-3244
Provider Enumeration Date:
01/20/2012