Provider First Line Business Practice Location Address:
617 23RD ST
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-325-1151
Provider Business Practice Location Address Fax Number:
606-324-4168
Provider Enumeration Date:
12/14/2005