Provider First Line Business Practice Location Address:
1629 ASHLAND ROAD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
GREENUP
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-473-2132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2008