Provider First Line Business Practice Location Address:
1200 CENTRAL AVE
Provider Second Line Business Practice Location Address:
STE. 2
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-325-9769
Provider Business Practice Location Address Fax Number:
606-329-3901
Provider Enumeration Date:
11/27/2007