Provider First Line Business Practice Location Address:
2245 WINCHESTER AVE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-324-2554
Provider Business Practice Location Address Fax Number:
606-324-2581
Provider Enumeration Date:
11/28/2012