Provider First Line Business Practice Location Address:
1212 BATH AVE
Provider Second Line Business Practice Location Address:
STE 535
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-447-5904
Provider Business Practice Location Address Fax Number:
866-273-5772
Provider Enumeration Date:
09/30/2013