Provider First Line Business Practice Location Address:
5900 ROUTE US 60 W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41102-9508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-928-5116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2020