Provider First Line Business Practice Location Address:
2301 LEXINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-325-9633
Provider Business Practice Location Address Fax Number:
606-325-9634
Provider Enumeration Date:
12/16/2009