Provider First Line Business Practice Location Address:
613 23RD ST
Provider Second Line Business Practice Location Address:
STE 230
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-324-4745
Provider Business Practice Location Address Fax Number:
606-326-0165
Provider Enumeration Date:
10/25/2005