Provider First Line Business Practice Location Address:
12219 MIDLAND TRAIL RD
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:
41102-7766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-929-1160
Provider Business Practice Location Address Fax Number:
606-928-2685
Provider Enumeration Date:
01/03/2007