Provider First Line Business Practice Location Address:
1536 WINCHESTER AVE
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-326-9888
Provider Business Practice Location Address Fax Number:
606-324-0057
Provider Enumeration Date:
12/29/2005