Provider First Line Business Practice Location Address:
1212 BATH AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-393-5926
Provider Business Practice Location Address Fax Number:
606-393-5613
Provider Enumeration Date:
12/02/2008