Provider First Line Business Practice Location Address:
BOX 11
Provider Second Line Business Practice Location Address:
5850 US 60
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-929-9155
Provider Business Practice Location Address Fax Number:
606-929-9833
Provider Enumeration Date:
01/30/2007